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Implication of total tumor size on the prognosis of patients with clinical stage IA lung adenocarcinomas appearing as part-solid nodules: Does only the solid portion size matter?

 Hyungjin Kim  ;  Jin Mo Goo  ;  Young Joo Suh  ;  Chang Min Park  ;  Young Tae Kim 
 European Radiology, Vol.29(3) : 1586-1594, 2019 
Journal Title
Issue Date
Adenocarcinoma of Lung/diagnostic imaging ; Adenocarcinoma of Lung/pathology* ; Aged ; Disease-Free Survival ; Female ; Humans ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/pathology* ; Lymph Nodes/pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed ; Tumor Burden*
Adenocarcinoma ; Disease-free survival ; Lung neoplasms ; Neoplasm staging ; Prognosis
OBJECTIVES: The aim was to investigate the effect of clinico-radiologic variables, including total tumor (Ttotal) size and clinical T category, on the prognosis of patients with stage IA (T1N0M0) lung adenocarcinomas appearing as part-solid nodules (PSNs). METHODS: This institutional review board-approved retrospective study included 506 patients (male:female = 200:306; median age, 62 years) with PSNs of the adenocarcinoma spectrum in clinical stage IA who underwent standard lobectomy at a single tertiary medical center. Prognostic stratification of the patients in terms of disease-free survival was analyzed with variables including age, sex, Ttotal size, solid portion size, clinical T category, and tumor location using univariate and subsequent multivariate Cox regression analysis. Subgroup analysis was performed to reveal the effect of the Ttotal size at each clinical T category. RESULTS: Multivariate Cox regression analysis demonstrated that Ttotal size*cT1b [interaction term; hazard ratio (HR) = 1.091; 95% confidence interval (CI): 1.015, 1.173; p = 0.019] and cT1c (HR = 68.436; 95% CI: 2.797, 1674.415; p = 0.010) were independent risk factors for the tumor recurrence. When patients with cT1b were dichotomized based on a Ttotal size cutoff of 3.0 cm, PSNs with Ttotal > 3.0 cm showed a significantly worse outcome (HR = 3.796; 95% CI: 1.006, 14.317; p = 0.049). No significant difference was observed in the probability of recurrence between cT1b with Ttotal > 3.0 cm and cT1c (p = 0.915). CONCLUSIONS: Ttotal size is a significant prognostic factor in adenocarcinoma patients in cT1b without lymph node or distant metastasis. PSNs in cT1b with Ttotal > 3.0 cm have a comparable risk of lung cancer recurrence to those in cT1c. KEY POINTS: • Current T descriptor was a powerful prognostic factor in stage IA adenocarcinomas appearing as part-solid nodules. • Total tumor size further stratified risk of recurrence of adenocarcinomas in cT1b. • Upstaging of tumors in cT1b with total tumor size > 3.0 cm may be more appropriate.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Suh, Young Joo(서영주) ORCID logo https://orcid.org/0000-0002-2078-5832
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